The study aimed to establish the role of weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E). One hundred and twenty-eight adolescent patients with... more
The study aimed to establish the role of weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E). One hundred and twenty-eight adolescent patients with anorexia nervosa (128 females and 2 males), aged between 14 and 19 years, were recruited from consecutive referrals to a community-based eating disorder clinic offering intensive CBT-E. Weight, height, Eating Disorder Examination Questionnaire, and Brief Symptom Inventory scores were recorded at admission, end-of-treatment, and at a 20-week follow-up. In addition, the developmental weight suppression (DWS, difference between one’s highest premorbid and current z-BMI, i.e., BMI z-scores) was calculated. The mean baseline z-BMI was −4.01 (SD = 2.27), and the mean DWS was 4.2 (SD = 2.3). One hundred and seven patients (83.4%) completed the treatment and showed both considerable weight gain and reduced scores for eating-disorder and general psychopathology. ...
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L’ictus e un importante problema di salute pubblica, e causa di morte e disabilita nella popolazione anziana. La necessita di strategie di prevenzione secondaria e terziaria per migliorare il funzionamento post-ictus e prevenire o... more
L’ictus e un importante problema di salute pubblica, e causa di morte e disabilita nella popolazione anziana. La necessita di strategie di prevenzione secondaria e terziaria per migliorare il funzionamento post-ictus e prevenire o ritardare altre condizioni disabilitanti, ha portato l’Italia a sviluppare un intervento di Attivita Fisica Adattata (AFA) per l’ictus, che permettesse di migliorare gli esiti della riabilitazione. Obiettivo dello studio e di valutare se l’AFA unita all’Educazione Terapeutica (ET), rispetto al trattamento riabilitativo standard, migliora il funzionamento e la qualita di vita in pazienti con ictus. Studio clinico non randomizzato, in cui sono stati valutati 229 pazienti in riabilitazione post-ictus, 126 nel gruppo sperimentale (AFA+ET) e 103 nel gruppo di controllo. I pazienti sono stati valutati al baseline, a 4 e a 12 mesi di follow-up. Le misure di esito sono il cambiamento a 4 mesi di follow-up (che corrisponde a 2 mesi post-intervento nel gruppo sperim...
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Aims.To study the potential use of child behaviour checklist (CBCL) 1.5–5 scales for the early identification of preschoolers at risk of autism.Methods.CBCL scores of three groups of preschoolers were compared: (1) an experimental group... more
Aims.To study the potential use of child behaviour checklist (CBCL) 1.5–5 scales for the early identification of preschoolers at risk of autism.Methods.CBCL scores of three groups of preschoolers were compared: (1) an experimental group of 101 preschoolers with autism spectrum disorder (ASD); (2) a control group of 95 preschoolers with other psychiatric disorders (OPD); (3) a control group of 117 preschoolers with typical development (TD). One-way analysis of variance (ANOVA), logistic regression with odds ratio (OR) and receiver operating characteristic (ROC) analyses were performed.Results.ANOVA revealed that ASD and OPD had significantly higher scores in almost all CBCL scales than TD. ASD presented significantly higher scores than OPD on Withdrawn, Attention Problems and Pervasive Developmental Problems (PDP) scales. Logistic regression analysis demonstrated that these same CBCL scales have validity in predicting the presence of an ASD towards both TD and OPD. ROC analysis indic...
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ABSTRACT Premessa. Recenti studi evidenziano l’importanza di raccogliere le valutazioni dei pazienti sulla propria esperienza di cura e il dibattito sui differenti approcci per farlo. Nel sistema dei servizi oncologici, questo diventa... more
ABSTRACT Premessa. Recenti studi evidenziano l’importanza di raccogliere le valutazioni dei pazienti sulla propria esperienza di cura e il dibattito sui differenti approcci per farlo. Nel sistema dei servizi oncologici, questo diventa particolarmente complesso, poiché richiede la considerazione di molteplici aspetti. Obiettivo e metodi. Lo studio è parte di un progetto di ricerca che ha l’obiettivo finale di valutare la continuità di cura nei servizi oncologici dalla prospettiva del paziente. In particolare, questo studio ha indagato l’esperienza di persone con neoplasia alla mammella e/o al colon retto nei servizi della Rete Oncologica di Area Vasta Romagna e si è sviluppato attraverso le seguenti fasi: interviste preliminari a 30 pazienti; analisi della letteratura sugli strumenti di valutazione; indagine di scopo attraverso la somministrazione di un questionario a 310 pazienti. Risultati. Dai risultati emergono alcuni aspetti dell’organizzazione che incidono nelle esperienze indagate, e che rappresentano ambiti di miglioramento nella rete dei servizi oncologici, tra cui: qualità comunicativa e informativa; qualità relazionale; individuazione precisa di un coordinatore del percorso; riconoscimento del ruolo del medico di medicina generale nella costruzione del percorso di cura; collaborazione e continuità informativa tra i professionisti ospedalieri.
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To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not... more
To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not satisfying DSM-IV criteria for Axis I mood disorders were evaluated with the Lifetime Mood Spectrum Self-Report (MOODS-SR) and the Mini-International Neuropsychiatric Interview (MINI). The MOODS-SR explored the subthreshold comorbidity for mood spectrum symptoms in patients not reaching the threshold for a mood disorder Axis I diagnosis. MOODS-SR included 161 items. Separate factor analyses of MOODS-SR identified 6 'depressive factors' and 9 'manic-hypomanic factors'. The mean total score of MOODS-SR was significantly higher in BN than in AN-R patients (97.5 ± 25.4 vs 61.1 ± 38.5, respectively; p = 0.0001). 63.6 % of the sample (n = 35) endorsed the threshold of ≥61 items, with a statistically significant difference between AN-R and B...
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Self-efficacy is an important mediator of the adaptation process after stroke. However, few studies have attempted to measure self-efficacy in a stroke population. The most recently developed scale is the Stroke Self-Efficacy... more
Self-efficacy is an important mediator of the adaptation process after stroke. However, few studies have attempted to measure self-efficacy in a stroke population. The most recently developed scale is the Stroke Self-Efficacy Questionnaire that measures self-efficacy ratings in specific domains of functioning relevant for a stroke survivor. The aim of this study was to validate the Italian version of Stroke Self-efficacy Questionnaire in stroke survivors. Cross-sectional study. Three Physical Medicine and Rehabilitation Units located in public hospitals. 149 adult patients recruited after their first stroke. Patients were assessed using the Self-efficacy in stroke survivors questionnaire, the Modified Barthel Index, the Geriatric Depression Scale and the Short Form Health Survey. Patients (38.3% female, mean age 69.3 years) completed the Self-efficacy in stroke survivors questionnaire with the help of an interviewer. Using confirmatory factor analysis two factors were identified (ac...
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Objective: The aim of this paper is to provide an overview of the self-report and interview-based instruments to assess mania/hypomania symptoms and related features, with a focus on 7 selected instruments in widespread use to illustrate... more
Objective: The aim of this paper is to provide an overview of the self-report and interview-based instruments to assess mania/hypomania symptoms and related features, with a focus on 7 selected instruments in widespread use to illustrate their psychometric properties, comparative performance and pros and cons. Methods: A systematic search strategy was devised and queried on Medline from 1973 to 2012 using the terms mania, hypomania, instrument, scale, questionnaire, interview, validity, reliability, psychometric properties and adults, elderly, aged. To be included, a study had to be published in a peer-reviewed journal or book in English or Italian. Results: Of the 17 self-report instruments identified, two (the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32), received the most research attention. Although the psychometric properties of these instruments are good, their use as screening instruments to detect hypomania in the community or in patients with de...
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Multiple studies indicate that bipolar disorders are often underrecognized, misdiagnosed, and incorrectly treated. The aim of the present report is to determine which combination of clinical, demographic, and psychopathological factors... more
Multiple studies indicate that bipolar disorders are often underrecognized, misdiagnosed, and incorrectly treated. The aim of the present report is to determine which combination of clinical, demographic, and psychopathological factors and corresponding cutoff scores best discriminate patients with unipolar disorder from those with bipolar disorders. The study sample includes outpatients and inpatients (N = 1,158) participating in 5 studies carried out in the United States and Italy between October 2001 and March 2008, one of which was a randomized clinical trial. Diagnostic assessment was carried out with the SCID, which allows diagnoses to be made according to DSM-IV-TR criteria. Using an exploratory statistical approach based on a classification tree, we employed 5 mania spectrum factors and 6 depression spectrum factors derived from the Mood Spectrum Self-Report Instrument (MOODS-SR) in combination with demographic and clinical characteristics to discriminate participants with unipolar versus bipolar disorders. The psychomotor activation factor, assessing the presence of thought acceleration, distractibility, hyperactivity, and restlessness for 1 or more periods of at least 3 to 5 days in the lifetime, identified subgroups with an increasing likelihood of bipolar disorder diagnosis. Mixed instability and suicidality contributed to further subtyping the sample into mutually exclusive groups, characterized by a different likelihood of receiving a diagnosis of bipolar disorder. Of the demographic and clinical characteristics included in the analysis, only sex proved to be useful to improve the discrimination. The psychomotor activation factor proved to be the most potent discriminator of those with unipolar versus bipolar diagnoses. The items that constitute this factor, together with those that constitute the mixed instability, suicidality, and euphoria factors, might be useful in making the differential diagnosis.
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Objective: Self-management is recommended in stroke rehabilitation. This report aims to describe timing, contents, and setting of delivery of a patient-centered, self-management program for stroke survivors in their early hospital... more
Objective: Self-management is recommended in stroke rehabilitation. This report aims to describe timing, contents, and setting of delivery of a patient-centered, self-management program for stroke survivors in their early hospital rehabilitation phase: the Look After Yourself (LAY) intervention. Methods: After extensive literature search, the LAY intervention was developed by integrating the Chronic Disease Self-Management Program, based on the self-efficacy construct of social cognitive theory, with evidence-based key elements and input from stroke survivors. Results: the LAY intervention aims to implement self-management skills in stroke survivors, enabling them to be active in goal setting and problem solving using action plans and to facilitate the critical transition from hospital to community. It includes both group sessions to facilitate sharing of experiences, social comparison, vicarious learning, and increase motivation and one-to-one sessions focused on setting feasible a...
Research Interests: Rehabilitation, Stroke rehabilitation, Self Management, Medicine, Multidisciplinary, and 11 moreActivities of Daily Living, Self Efficacy, Patient education, Stroke, Humans, Survivors, Environmental public health, Chronic Disease, Checklist, Two Stroke Engine, and Guidance and Counseling Intervention Programs
Few tools to encourage therapists to implement evidence based psychological treatments as designed exist. Assessing therapist “competence” (implementing therapeutic procedures well) by evaluating the quality of their treatment sessions is... more
Few tools to encourage therapists to implement evidence based psychological treatments as designed exist. Assessing therapist “competence” (implementing therapeutic procedures well) by evaluating the quality of their treatment sessions is problematic for multiple reasons. Therapist self-rated measures of “adherence” (using the correct therapeutic procedures) may offer a viable alternative. We describe (i) the development of a CBT-E Components Checklist (CBT-E CC) for therapists, as well as (ii) how to use the CBT-E CC and where to access it. The CBT-E CC is an adherence checklist for enhanced cognitive behavior therapy for eating disorders (CBT-E). It is intended as a formative tool for therapists to assess, and improve as needed, their own adherence. Future research on the validity of the checklist to accurately measure adherence is needed.
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Cognitive behavioural therapy for obesity (CBT-OB) is an individual treatment for adults, and it therefore does not involve others as a matter of routine. However, there are two specific indications for involving significant others: (1)... more
Cognitive behavioural therapy for obesity (CBT-OB) is an individual treatment for adults, and it therefore does not involve others as a matter of routine. However, there are two specific indications for involving significant others: (1) if others could help the patient to make positive changes and (2) if others are making it difficult for the patient to change, for example, by negatively commenting on their body weight or eating habits. If the therapist and patient jointly decide that it would be useful to involve family members, such meetings should take place at the end of a routine individual session. It is important to include the following steps: (1) an introduction by the therapist and a statement about the aims of the meeting; (2) the patient’s explanation of CBT-OB and its rationale; (3) listening to the significant other’s (or others’) points of view, answering their questions and addressing any problems they report; (4) discussing how they could be of practical aid to the patient; and (5) discussing how they could reduce their critical attitude towards the patient’s eating, shape and weight. In general, three or four joint sessions with significant others are planned in about half of the patients we treat. In addition to the direct involvement of family members, CBT-OB also provides patients with some practical strategies for seeking social support from significant others not involved in the dedicated sessions.
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Attrition in weight loss programs is a complex process, influenced by patients’ pretreatment characteristics and treatment variables, but available data are contradictory. Only a few variables have been confirmed by more than one study as... more
Attrition in weight loss programs is a complex process, influenced by patients’ pretreatment characteristics and treatment variables, but available data are contradictory. Only a few variables have been confirmed by more than one study as relevant risk factors, but recently new data of clinical utility emerged from “real world” large observational studies. Practical difficulties, unsatisfactory results, a few psychological variables (e.g. lack of motivation, unrealistic weight loss expectations, overall level of stress, self-confidence in the ability to lose additional weight without professional help, and sense of abandonment from therapists), seem to play a crucial role in the patients’ decision of interrupting the weight loss treatment.
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Module 2 of cognitive behavioural therapy for obesity (CBT-OB) trains the patients to change their eating habits to produce a 500–1000 kcal energy deficit per day. This should provide a weight loss of about 0.5–1 kg/week, although results... more
Module 2 of cognitive behavioural therapy for obesity (CBT-OB) trains the patients to change their eating habits to produce a 500–1000 kcal energy deficit per day. This should provide a weight loss of about 0.5–1 kg/week, although results will vary patient by patient and week by week. Patients are encouraged to follow a low-energy eating plan based on the Italian Mediterranean diet, but this should be adapted to the preferences and characteristics of the individual, as well as the patient’s personal metabolic targets. To improve adherence to dietary restriction, CBT-OB suggests that patients adopt the following three procedures: (1) planning ahead when, what and where to eat in the Monitoring Record, (2) monitoring food intake in real time in the Monitoring Record and (3) eating consciously (i.e. slowly, while appreciating the smell and taste of food) and adopting a mindset focused on weight control. Patients are advised to follow the meal plan without being influenced by external or internal stimuli that may negatively influence their adherence. They are encouraged to tolerate the short-term aversive experiences and loss of pleasure that they may experience when following an energy-restricted meal plan and instead to focus on their long-term goals (e.g. reaching a healthy weight loss and its associated physical and psychological advantages).
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OBJECTIVE This study was designed to compare the change in eating-disorder feature networks in patients with anorexia nervosa after treatment with intensive enhanced cognitive behavior therapy (CBT-E). METHODS Patients seeking treatment... more
OBJECTIVE This study was designed to compare the change in eating-disorder feature networks in patients with anorexia nervosa after treatment with intensive enhanced cognitive behavior therapy (CBT-E). METHODS Patients seeking treatment for anorexia nervosa were consecutively recruited from January 2016 to September 2020. All patients aged ≥16 years who completed a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment) were included in the study. Body mass index (BMI) was measured, and the Eating Disorder Examination Questionnaire completed for each patient, both at baseline and the end of treatment. RESULTS The sample comprised 214 patients with anorexia nervosa. Treated patients showed significant improvements in BMI and eating-disorder psychopathology. Network analysis revealed a significant reduction in the network global and connection strengths at the end of treatment. The most central and highly interconnected nodes in the network at baseline were related to the drive for thinness, but at the end of treatment to body image concerns. Some edge connections were significantly stronger at baseline than at the end of treatment, while others were significantly stronger at the end of treatment than at baseline. DISCUSSION CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa. The differences in central nodes and edge connections between baseline and end of treatment, not detected by classical inferential analysis, may be informative for understanding the centrality of symptoms in the psychopathology network, and how a specific treatment may act to reduce symptoms and change their connections over time.
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Background Dietary rules are common in patients with eating disorders, and according to transdiagnostic cognitive behavioural theory for eating disorders, represent a key behaviour maintaining eating-disorder psychopathology. The aim of... more
Background Dietary rules are common in patients with eating disorders, and according to transdiagnostic cognitive behavioural theory for eating disorders, represent a key behaviour maintaining eating-disorder psychopathology. The aim of this study was to describe the design and validation of the Dietary Rules Inventory (DRI), a new self-report questionnaire that assesses dietary rules in patients with eating disorders. Methods A transdiagnostic sample of 320 patients with eating disorders, as well as 95 patients with obesity and 122 healthy controls were recruited. Patients with eating disorders also completed the Dutch Eating Behaviour Questionnaire (DEBQ), the Eating Disorder Examination Questionnaire, the Brief Symptoms Inventory and the Clinical Impairment Assessment. Dietary rules were rated on a continuous Likert-type scale (0–4), rating how often (from never to always) they had been applied over the previous 28 days. Results DRI scores were significantly higher in patients with eating disorders than in patients with obesity and healthy controls. Principal factor analysis identified that 55.8% of the variance was accounted for by four factors, namely ‘what to eat’, ‘social eating’, ‘when and how much to eat’ and ‘caloric level’. Both global score and subscales demonstrated high internal and test–retest reliability. The DRI global score was significantly correlated with the DEBQ ‘restrained eating’ subscale, as well as eating-disorder and general psychopathology and clinical impairment scores, demonstrating good convergent validity. Conclusions These findings suggest that the DRI is a valid self-report questionnaire that may provide important clinical information regarding the dietary rules underlying dietary restraint in patients with eating disorders. Level of evidence V, descriptive study
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Personalized cognitive-behavioural therapy for obesity (CBT-OB) is a new treatment that combines the traditional procedures of standard behavioural therapy for obesity (i.e., self-monitoring, goal setting, stimulus control, contingency... more
Personalized cognitive-behavioural therapy for obesity (CBT-OB) is a new treatment that combines the traditional procedures of standard behavioural therapy for obesity (i.e., self-monitoring, goal setting, stimulus control, contingency management, behavioural substitution, skills for increasing social support, problem solving and relapse prevention) with a battery of specific cognitive strategies and procedures. These enable the treatment to be individualized, and to help patients to address the cognitive processes that previous research has found to be associated with treatment discontinuation, the amount of weight lost and long-term weight-loss maintenance. The treatment programme can be delivered at three levels of care, outpatient, day hospital and residential, and includes six modules, which are introduced according to the individual patient’s needs as part of a flexible, personalized approach. The primary goals of CBT-OB are to help patients to (i) achieve, accept and maintain...
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This study aimed to evaluate the presence of the overvaluation of shape and weight and its associated features in patients with obesity but no eating disorder who were seeking treatment from a specialist unit.
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Background: The aim of this study was to investigate the interconnections between specific quality-of-life domains in patients with obesity and high or low physical performance using a network approach. Methods: 716 consecutive female and... more
Background: The aim of this study was to investigate the interconnections between specific quality-of-life domains in patients with obesity and high or low physical performance using a network approach. Methods: 716 consecutive female and male patients (aged 18–65 years) with obesity seeking weight-loss treatment were included. The 36-item Short Form Health Survey (SF-36) and the six-minute walking test (6MWT) were used to assess quality of life and physical performance, respectively. The sample was split into two groups according to the distance walked in the 6MWT. Network structures of the SF-36 domains in the two groups were assessed and compared, and the relative importance of individual items in the network structures was determined using centrality analyses. Results: 35.3% (n = 253) of participants covered more distance than expected, and 64.7% (n = 463) did not. Although low-performing patients showed lower quality of life domain scores, the network structures were similar in...
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BackgroundThe aim of this paper is to give a conceptual comparison of family-based treatment (FBT), a specific form of family therapy, and enhanced cognitive behavior therapy (CBT-E) in the management of adolescents with eating... more
BackgroundThe aim of this paper is to give a conceptual comparison of family-based treatment (FBT), a specific form of family therapy, and enhanced cognitive behavior therapy (CBT-E) in the management of adolescents with eating disorders.Main textFBT and CBT-E differ in the conceptualization of eating disorders, the nature of involvement of parents and the child/adolescent, the number of treatment team members involved, and evidence of efficacy. FBT is the leading recommended empirically- supported intervention for adolescents with eating disorders. Data from randomized controlled trials indicate that FBT works well with less than half of the parents and adolescents who accept the treatment, but cannot be used with those who do not have available parents, or for those with parents who are not accepting of a FBT model, or are unable to participate in a course of this treatment. CBT-E has shown promising results in cohort studies of patients between ages 11 and 19 years, and has recen...
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The aim of this study was to evaluate the change in starvation symptoms over time and their role as potential predictors of change in eating disorder and general psychopathology in patients with anorexia nervosa treated by means of... more
The aim of this study was to evaluate the change in starvation symptoms over time and their role as potential predictors of change in eating disorder and general psychopathology in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioral therapy (ICBT-E). Ninety adult female patients with anorexia nervosa (63 restricting type and 27 binge-eating/purging type) were recruited. Body mass index (BMI), Eating Disorder Examination (EDE) interview, Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI) and Starvation Symptoms Inventory (SSI) scores were recorded at admission, at the end of treatment, and at 6-month follow-up. All tests, except for the EDE, were also administered after 4 weeks of treatment to assess the role of refeeding on these variables. At baseline, starvation symptoms were correlated with measures of eating disorder and general psychopathology. The treatment was associated with a significant increase in BMI, i...
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The aim of this study was to assess the association between weight-loss maintenance and weight-loss satisfaction, adherence to diet and weight loss, all measured session-by-session during the weight-loss phase of cognitive behavioral... more
The aim of this study was to assess the association between weight-loss maintenance and weight-loss satisfaction, adherence to diet and weight loss, all measured session-by-session during the weight-loss phase of cognitive behavioral therapy. The present exploratory study examined a subgroup of fifty-eight patients who participated in a randomized controlled trial and who lost at least the 10% of their baseline weight. Patients were grouped into weight-loss 'Maintainers' (i.e., those who maintained a weight loss of ≥ 10% of baseline body weight at 6 months after the weight-loss phase) and 'Regainers' (i.e., those who did not maintain > 10% weight loss at 6 months after the weight-loss phase). Body weight, adherence to diet and weight-loss satisfaction were measured session-by-session during the weight-loss phase. Thirteen patients (22.4%) were classified as 'Regainers', and 45 (77.6%) as 'Maintainers'. Compared to 'Maintainers', 'Regain...
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Severe obesity is difficult to treat, and non-surgical treatment is not supported by robust evidence. The aim of the present study was to establish the immediate and longer-term outcomes following "personalized" form of group... more
Severe obesity is difficult to treat, and non-surgical treatment is not supported by robust evidence. The aim of the present study was to establish the immediate and longer-term outcomes following "personalized" form of group cognitive behavioural therapy for obesity (CBT-OB)-a new treatment designed to address specific cognitive processes that have been associated with attrition, weight loss, and weight maintenance in previous studies. Sixty-seven adult patients with obesity (body mass index (BMI) ≥ 30 kg/m) were recruited from consecutive referrals to an Italian National Health Service obesity clinic. Each patient was offered 22 group sessions of CBT-OB (14 in the 6-month weight-loss phase and 8 in the subsequent 12-month weight-maintenance phase). 76.2% patients completed the treatment, with an average weight loss of 11.5% after 6 months (10% in the intention-to-treat analysis) and 9.9% (7.5% in the intention-to-treat analysis) after 18 months. Weight loss was associate...
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The aim of this study was to validate the latest version of the Eating Problem Checklist (EPCL), a tool designed to assess eating-disorder behaviours and psychopathology in patients with eating disorders, session-by-session. The EPCL was... more
The aim of this study was to validate the latest version of the Eating Problem Checklist (EPCL), a tool designed to assess eating-disorder behaviours and psychopathology in patients with eating disorders, session-by-session. The EPCL was completed at baseline by participants with eating disorders (n = 161) and a healthy control group (n = 379) and then administered session-by-session in a subgroup of 75 participants with eating disorders. The EPCL demonstrated good internal consistency, test-retest reliability, and concurrent and criterion validity, and principal axis analysis of the session-by-session data identified two factors ('eating concerns' and 'body image concerns') that accounted for 51.3% of the variance. Furthermore, session-by-session analysis indicated that the EPCL is able to identify specific weekly improvements and/or deterioration in eating-disorder psychopathology. These findings suggest that the EPCL is a valid and reliable self-report questionnai...
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No specific questionnaire that evaluates Health-Related Quality Of Life (HRQOL) in individuals with obesity is available in the Arabic language. The aim of this study was therefore to propose and examine the validity and reliability of an... more
No specific questionnaire that evaluates Health-Related Quality Of Life (HRQOL) in individuals with obesity is available in the Arabic language. The aim of this study was therefore to propose and examine the validity and reliability of an Arabic language version of the ORWELL 97, a validated obesity-related HRQOL questionnaire. The ORWELL 97 questionnaire was translated from English to Arabic language and administered to 318 Arabic-speaking participants (106 from clinical and 212 from community samples), and underwent internal consistency, test-retest reliability, construct and discriminative validity analysis. Internal consistency and the test-retest reliability were excellent for ORWELL 97 global scores in the clinical sample. Participants with obesity displayed significantly higher ORWELL 97 scores than participants from the community sample, confirming the good discriminant validity of the questionnaire. Confirmatory factor analysis in the clinical sample revealed a good fit for...
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Some personality traits seem to be associated with obesity, but there is little information available regarding their association with obesity treatment outcomes. The aim of this systematic review was therefore to assess the associations... more
Some personality traits seem to be associated with obesity, but there is little information available regarding their association with obesity treatment outcomes. The aim of this systematic review was therefore to assess the associations between personality traits-evaluated by means of the Temperament and Character Inventory (TCI)-and outcomes of obesity treatment, including attrition, weight loss, and weight loss maintenance. The PubMed database was searched, and studies were screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and data were collated using a narrative approach. Of the 886 articles retrieved, 9 studies assessing personality traits by means of the TCI in participants with obesity met the inclusion criteria and were reviewed. This approach revealed three main findings: (i) only one study found that attrition rate-during a 6-month behavioral weight loss program-is predicted by low reward dependence scores at baselin...
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We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived... more
We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived treatment needs, readiness and self-confidence to be successful and a battery of psychopathology questionnaires in 793 subjects with obesity (68% women; mean age 48.7; 46% obesity class III) enrolled into a group-based cognitive-behavioral treatment program. Their relevance on attrition and successful weight loss outcome were tested by logistic regression analysis. The expected benefits of weight loss scored very high in all physical, psychological and social areas, with differences between genders. Attrition rate was 24, 41 and 65% at 6-, 12-, and 24-month follow-up. Average weight loss was 5.8 ± 7.1 kg (- 4.8%) at 6 months, with 17% of cases (32% of continuers) maintaining weight loss > 10% at 24 months. After adjustment for confounders, attrition was...
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Although weight cycling is a common phenomenon in treatment-seeking patients with obesity, its consequences on health outcomes have not yet been completely clarified. We therefore aimed to investigate the effect of one cycle of... more
Although weight cycling is a common phenomenon in treatment-seeking patients with obesity, its consequences on health outcomes have not yet been completely clarified. We therefore aimed to investigate the effect of one cycle of intentional weight loss and regain on energy expenditure, body composition, cardiovascular risk factors and psychosocial variables in patients with severe obesity. Clinical and psychosocial variables were measured in 38 adult patients with severe obesity (body mass index (BMI): 43.5 ± 7.2 kg/m(2) ) consecutively readmitted to rehabilitative residential treatment (T1) for severe obesity after a cycle of weight loss (16.7 ±7.7 kg) and regain (15.1 ±11.3 kg), and compared with those recorded at a prior admission (T0). No significant differences were found between T0 and T1 values for weight, BMI, waist circumference, total body fat percentage, fat-free mass percentage, respiratory quotient, measured or predicted resting energy expenditure, metabolic adaptation, ...
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Obesity is a growing health problem worldwide. It is associated with serious medical and psychosocial comorbidities that increase the risk of mortality. However, strong evidence confirms lifestyle-modification programs as the cornerstone... more
Obesity is a growing health problem worldwide. It is associated with serious medical and psychosocial comorbidities that increase the risk of mortality. However, strong evidence confirms lifestyle-modification programs as the cornerstone treatment for excess weight and obesity. The aim of this systematic review was to assess the effectiveness of the lifestyle-modification programs for weight management delivered in Arabic-speaking countries. The PubMed database was searched, and studies conducted in humans were identified and screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 1057 articles retrieved, six studies, conducted in four Arab countries, comprising a total of 444 adolescent and adult participants of both genders with overweight and obesity, met the inclusion criteria and were reviewed. Most studies that assessed weight loss at 6-month follow-up sho...
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Research Interests: Psychology, Psychiatry, Menstruation, Adolescent, Medicine, and 15 moreLogistic Regression, Anorexia Nervosa, Biological Psychiatry, Humans, Outcome, Female, Exercise, Menstrual Cycle, Body Mass Index, Adult, Body Weight, Inpatients, Inpatient Treatment, Patient discharge, and Medical and Health Sciences
The aim of this prospective case-control study was to compare the long-term effects of a residential cognitive-behavioral treatment (CBT) for weight loss in severely obese patients with and without binge-eating disorder (BED). We assessed... more
The aim of this prospective case-control study was to compare the long-term effects of a residential cognitive-behavioral treatment (CBT) for weight loss in severely obese patients with and without binge-eating disorder (BED). We assessed weight-loss outcomes and psychological impairment in 54 severely obese female patients with BED and 54 patients matched by age, gender, and body mass index (BMI) without BED admitted to a residential CBT program. Body weight was measured at baseline and at 6-month follow-up and was reported by patients in a telephone interview at 5-year follow-up. Depression, eating disorder psychopathology, general psychopathology, and quality of life were assessed using validated instruments at baseline and at 6-month follow-up. Obese patients with and without BED had similar weight loss at 6-month and 5-year follow-ups. Although both groups showed improved psychosocial variables, at 6 months the BED group maintained higher psychological impairment. Nevertheless, at 5-year follow-up more than half of the BED participants were no longer classifiable as having BED. The presence of BED does not affect weight-loss outcome in obese patients treated with the residential CBT for weight loss program considered. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:723-730).